| NPI | 1720492069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 271807) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 260012) |
| Enumeration Date | 2014-06-15 |
| Last Update Date | 2018-05-15 |